Research

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12 pages, 1149 KiB

Open AccessArticle

Clinical Utility of Baseline Brain Natriuretic Peptide Levels on Health Status Outcomes after Catheter Ablation for Atrial Fibrillation in Individuals without Heart Failure

by Shin Kashimura, Nobuhiro Ikemura, Shun Kohsaka, Yoshinori Katsumata, Takehiro Kimura, Daisuke Shinmura, Kotaro Fukumoto, Koji Negishi, Ikuko Ueda, Seiji Takatsuki and Masaki Ieda

J. Clin. Med. 2024, 13(2), 407; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13020407 - 11 Jan 2024

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Abstract

Background: Catheter ablation (CA) benefits atrial fibrillation (AF) patients with heart failure (HF). Brain natriuretic peptide (BNP), a marker of left-ventricular pressure load, may serve as a potential surrogate for predicting quality of life (QOL) in a broader range of patients. Methods: Within [...] Read more.

Background: Catheter ablation (CA) benefits atrial fibrillation (AF) patients with heart failure (HF). Brain natriuretic peptide (BNP), a marker of left-ventricular pressure load, may serve as a potential surrogate for predicting quality of life (QOL) in a broader range of patients. Methods: Within the multicenter KiCS-AF registry, 491 AF patients underwent CA without clinical HF (e.g., documented history of HF, left ventricular ejection fraction ≤ 40%, or BNP levels ≥ 100 pg/mL). Participants, aged 61 ± 10 years, were categorized by baseline BNP quartiles. Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) questionnaire assessments were assessed at baseline and 1 year. Results: A lower baseline BNP correlated with reduced AFEQT scores. Post CA, all groups showed significant AFEQT score improvements. The lower-BNP group displayed notable enhancements (18.2 ± 1.2, 15.0 ± 1.1, 12.6 ± 1.2, 13.6 ± 1.2, p < 0.005), especially in symptom and treatment concern areas. Even those with normal BNP levels (≤18.4 pg/mL) exhibited significant QOL improvements. Comparing paroxysmal AF (PAF) and non-PAF groups, the PAF group, especially with higher BNP levels, showed greater AFEQT score improvements. Conclusions: This study establishes BNP as a predictive marker for QOL enhancement in non-HF patients undergoing CA for AF. BNP levels represent AF stages, with individuals in earlier stages, especially within normal BNP levels, experiencing greater QOL improvements. Full article

(This article belongs to the Special Issue Acute Heart Failure: Risk Prediction, Diagnosis, and Clinical Management)

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12 pages, 1234 KiB

Open AccessArticle

Low Energy Intake Diagnosed Using the Harris–Benedict Equation Is Associated with Poor Prognosis in Elderly Heart Failure Patients

by Akira Taruya, Tsuyoshi Nishiguchi, Shingo Ota, Motoki Taniguchi, Manabu Kashiwagi, Yasutsugu Shiono, Ke Wan, Yasushi Ino and Atsushi Tanaka

J. Clin. Med. 2023, 12(22), 7191; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12227191 - 20 Nov 2023

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Abstract

Introduction: Insufficient nutrient intake is a strong independent predictor of mortality in elderly patients with heart failure. However, it is unclear to what extent energy intake affects their prognosis. This study investigated the association between patient outcomes and actual measured energy intake in [...] Read more.

Introduction: Insufficient nutrient intake is a strong independent predictor of mortality in elderly patients with heart failure. However, it is unclear to what extent energy intake affects their prognosis. This study investigated the association between patient outcomes and actual measured energy intake in elderly patients (≥65 years) with heart failure. Methods: This study enrolled 139 elderly patients who were hospitalized with worsening heart failure at Shingu Municipal Medical Center, Shingu, Japan, between May 2017 and April 2018. Energy intake was evaluated for three days (from three days prior to the day of discharge until the day of discharge). Based on basal energy expenditure calculated using the Harris–Benedict equation, the patients were classified into a low-energy group (n = 38) and a high-energy group (n = 101). We assessed the prognosis in terms of both all-cause mortality and readmission due to worsening heart failure as a primary outcome. Results: Compared to the patients in the high-energy group, the patients in the low-energy group were predominantly female, less frequently had smoking habits and ischemic heart diseases, and had a higher left ventricular ejection fraction. The low-energy group had higher mortality than the high-energy group (p = 0.028), although the two groups showed equivalent event rates of the primary outcome (p = 0.569). Conclusion: Calculations based on the Harris–Benedict equation revealed no significant difference in the primary outcome between the two groups, with a secondary outcome that showed worse mortality in the low-energy group. Given this result, energy requirement-based assessments using the Harris–Benedict equation might help in the management of elderly heart failure patients in terms of improved life outcomes. Full article

(This article belongs to the Special Issue Acute Heart Failure: Risk Prediction, Diagnosis, and Clinical Management)

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11 pages, 635 KiB

Open AccessArticle

Hemodynamic Differences between Patients Hospitalized with Acutely Decompensated Chronic Heart Failure and De Novo Heart Failure

by Agata Galas, Paweł Krzesiński, Małgorzata Banak and Grzegorz Gielerak

J. Clin. Med. 2023, 12(21), 6768; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12216768 - 26 Oct 2023

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Abstract

Background: Heart failure (HF) is associated with high mortality, morbidity, and frequent hospitalizations due to acute HF (AHF) and requires immediate diagnosis and individualized therapy. Some differences between acutely decompensated chronic heart failure (ADCHF) and de novo HF (dnHF) patients in terms of [...] Read more.

Background: Heart failure (HF) is associated with high mortality, morbidity, and frequent hospitalizations due to acute HF (AHF) and requires immediate diagnosis and individualized therapy. Some differences between acutely decompensated chronic heart failure (ADCHF) and de novo HF (dnHF) patients in terms of clinical profile, comorbidities, and outcomes have been previously identified, but the hemodynamics related to both of these clinical states are still not well recognized. Purpose: To compare patients hospitalized with ADCHF to those with dnHF, with a special emphasis on hemodynamic profiles at admission and changes due to hospital treatment. Methods: This study enrolled patients who were at least 18 years old, hospitalized due to AHF (both ADCHF and dnHF), and who underwent detailed assessments at admission and at discharge. The patients’ hemodynamic profiles were assessed by impedance cardiography (ICG) and characterized in terms of heart rate (HR), blood pressure (BP), systemic vascular resistance index (SVRI), cardiac index (CI), stroke index (SI), and thoracic fluid content (TFC). Results: The study population consisted of 102 patients, most of whom were men (76.5%), with a mean left ventricle ejection fraction (LVEF) of 37.3 ± 14.1%. The dnHF patients were younger than the ADCHF group and more frequently presented with palpitations (p = 0.041) and peripheral hypoperfusion (p = 0.011). In terms of hemodynamics, dnHF was distinguished by higher HR (p = 0.029), diastolic BP (p = 0.029), SVRI (p = 0.013), and TFC (only numeric, p = 0.194) but lower SI (p = 0.043). The effect of hospital treatment on TFC was more pronounced in dnHF than in ADCHF, and this was also true of N-terminal pro-brain natriuretic peptide (NT-proBNP) and body mass. Some intergroup differences in the hemodynamic profile observed at admission persisted until discharge: higher HR (p = 0.002) and SVRI (trend, p = 0.087) but lower SI (p < 0.001) and CI (p = 0.023) in the dnHF group. Conclusions: In comparison to ADCHF, dnHF is associated with greater tachycardia, vasoconstriction, depressed cardiac performance, and congestion. Despite more effective diuretic therapy, other unfavorable hemodynamic features may still be present in dnHF patients at discharge. Full article

(This article belongs to the Special Issue Acute Heart Failure: Risk Prediction, Diagnosis, and Clinical Management)

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20 pages, 3046 KiB

Open AccessArticle

Integration of a Smartphone HF-Dedicated App in the Remote Monitoring of Heart Failure Patients with Cardiac Implantable Electronic Devices: Patient Access, Acceptance, and Adherence to Use

by Matteo Ziacchi, Giulio Molon, Vittorio Giudici, Giovanni Luca Botto, Miguel Viscusi, Francesco Brasca, Amato Santoro, Antonio Curcio, Michele Manzo, Erminio Mauro, Mauro Biffi, Alessandro Costa, Andrea Dell’Aquila, Maria Carla Casale and Giuseppe Boriani

J. Clin. Med. 2023, 12(17), 5528; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12175528 - 25 Aug 2023

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Abstract

(200 w) Introduction. Remote monitoring (RM) of cardiac implantable electronic device (CIED) diagnostics helps to identify patients potentially at risk of worsening heart failure (HF). Additionally, knowledge of patient HF-related symptoms is crucial for decision making. Patient smartphone applications may represent an ideal [...] Read more.

(200 w) Introduction. Remote monitoring (RM) of cardiac implantable electronic device (CIED) diagnostics helps to identify patients potentially at risk of worsening heart failure (HF). Additionally, knowledge of patient HF-related symptoms is crucial for decision making. Patient smartphone applications may represent an ideal option to remotely collect this information. Purpose. To assess real-world HF patient access, acceptance, and adherence to use of an HF-dedicated smartphone application (HF app). Methods. In this study, 10 Italian hospitals administered a survey on smartphone/app use to HF patients with CIED. The subgroup who accepted it downloaded the HF app. Mean 1-year adherence of the HF app use was evaluated. Results. A total of 495 patients (67 ± 13 years, 79% males, 26% NYHA III–IV) completed the survey, of which 84% had access to smartphones and 85% were willing to use the HF app. In total, 311/495 (63%) downloaded the HF app. Patients who downloaded the HF app were younger and had higher school qualification. Patients who were ≥60 years old had higher mean 1-year adherence (54.1%) than their younger counterparts (42.7%; p < 0.001). Hospitals with RM-dedicated staff had higher mean 1-year patient adherence (64.0% vs. 33.5%; p < 0.001). Adherence to HF app decreased from 63.3% (weeks_1–13) to 42.2% (weeks_40–52, p < 0.001). Conclusions. High access and acceptance of smartphones/apps by HF patients with CIED allow HF app use for RM of patient signs/symptoms. Younger patients with higher school qualifications are more likely to accept HF app; however, older patients have higher long-term adherence. Full article

(This article belongs to the Special Issue Acute Heart Failure: Risk Prediction, Diagnosis, and Clinical Management)

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9 pages, 721 KiB

Open AccessArticle

Persistent Hypochloremia Is Associated with Adverse Prognosis in Patients Repeatedly Hospitalized for Heart Failure

by Yuji Nozaki, Akiomi Yoshihisa, Yu Sato, Himika Ohara, Yukiko Sugawara, Satoshi Abe, Tomofumi Misaka, Takamasa Sato, Masayoshi Oikawa, Atsushi Kobayashi, Takayoshi Yamaki, Kazuhiko Nakazato and Yasuchika Takeishi

J. Clin. Med. 2023, 12(4), 1257; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12041257 - 05 Feb 2023

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Abstract

Background: Hypochloremia reflects neuro-hormonal activation in patients with heart failure (HF). However, the prognostic impact of persistent hypochloremia in those patients remains unclear. Methods: We collected the data of patients who were hospitalized for HF at least twice between 2010 and 2021 (n [...] Read more.

Background: Hypochloremia reflects neuro-hormonal activation in patients with heart failure (HF). However, the prognostic impact of persistent hypochloremia in those patients remains unclear. Methods: We collected the data of patients who were hospitalized for HF at least twice between 2010 and 2021 (n = 348). Dialysis patients (n = 26) were excluded. The patients were divided into four groups based on the absence/presence of hypochloremia (<98 mmol/L) at discharge from their first and second hospitalizations: Group A (patients without hypochloremia at their first and second hospitalizations, n = 243); Group B (those with hypochloremia at their first hospitalization and without hypochloremia at their second hospitalization, n = 29); Group C (those without hypochloremia at their first hospitalization and with hypochloremia at their second hospitalization, n = 34); and Group D (those with hypochloremia at their first and second hospitalizations, n = 16). Results: a Kaplan–Meier analysis revealed that all-cause mortality and cardiac mortality were the highest in Group D compared to the other groups. A multivariable Cox proportional hazard analysis revealed that persistent hypochloremia was independently associated with both all-cause death (hazard ratio 3.490, p < 0.001) and cardiac death (hazard ratio 3.919, p < 0.001). Conclusions: In patients with HF, prolonged hypochloremia over two hospitalizations is associated with an adverse prognosis. Full article

(This article belongs to the Special Issue Acute Heart Failure: Risk Prediction, Diagnosis, and Clinical Management)

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11 pages, 1374 KiB

Open AccessArticle

Association of Potassium Level at Discharge with Long-Term Mortality in Hospitalized Patients with Heart Failure

by Yusuke Miura, Satoshi Higuchi, Takashi Kohno, Yasuyuki Shiraishi, Mitsunobu Kitamura, Yuji Nagatomo, Makoto Takei, Shintaro Nakano, Ayumi Goda, Kyoko Soejima, Shun Kohsaka and Tsutomu Yoshikawa

J. Clin. Med. 2022, 11(24), 7358; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11247358 - 11 Dec 2022

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Abstract

Dyskalemia (hypokalemia and hyperkalemia) is a common comorbidity of heart failure (HF). Although dyskalemia is associated with poor prognosis, different prognostic impacts of hypo- and hyperkalemia remain vastly unclear. This study investigated the association of dyskalemia with prognosis in HF patients, especially the [...] Read more.

Dyskalemia (hypokalemia and hyperkalemia) is a common comorbidity of heart failure (HF). Although dyskalemia is associated with poor prognosis, different prognostic impacts of hypo- and hyperkalemia remain vastly unclear. This study investigated the association of dyskalemia with prognosis in HF patients, especially the mode of death and left ventricular ejection fraction (LVEF). The multicenter study included 3398 patients hospitalized for HF. Patients were divided into three groups based on serum potassium levels at discharge: hypokalemia (<3.5 mEq/L; n = 115 (3.4%)), normokalemia (3.5–5.0 mEq/L; n = 2960 (87.1%)), and hyperkalemia (≥5.0 mEq/L; n = 323 (9.5%)). Two-year all-cause, cardiac, and non-cardiac mortality was evaluated. Association of serum potassium with two-year mortality demonstrated a U-shaped curve, with a worse prognosis for patients with hypokalemia. All-cause mortality at two-years did not differ among the three groups. Hypokalemia was associated with 2-year cardiac death (adjusted hazard ratio (HR), 2.60; 95% confidence interval (CI), 1.20–5.64) in HF with reduced ejection fraction (HFrEF; LVEF < 40%), but not in non-HFrEF. Regardless of LVEF, hyperkalemia was not independently associated with any mortality. Hypokalemia was independently associated with cardiac death, particularly in HFrEF patients. Such an association was not observed in hyperkalemia regardless of LVEF. Full article

(This article belongs to the Special Issue Acute Heart Failure: Risk Prediction, Diagnosis, and Clinical Management)

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13 pages, 1138 KiB

Open AccessArticle

Prognostic Impact of the HFA-PEFF Score in Patients with Acute Myocardial Infarction and an Intermediate to High HFA-PEFF Score

by Kwan Yong Lee, Byung-Hee Hwang, Chan Jun Kim, Young Kyoung Sa, Young Choi, Jin-Jin Kim, Eun-Ho Choo, Sungmin Lim, Ik Jun Choi, Mahn-Won Park, Gyu Chul Oh, In-Ho Yang, Ki Dong Yoo, Wook Sung Chung and Kiyuk Chang

J. Clin. Med. 2022, 11(15), 4589; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11154589 - 05 Aug 2022

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Abstract

This study aimed to investigate the efficacy of the HFA-PEFF score in predicting the long-term risks in patients with acute myocardial infarction (AMI) and an HFA-PEFF score ≥ 2. The subjects were divided according to their HFA-PEFF score into intermediate (2–3 points) and [...] Read more.

This study aimed to investigate the efficacy of the HFA-PEFF score in predicting the long-term risks in patients with acute myocardial infarction (AMI) and an HFA-PEFF score ≥ 2. The subjects were divided according to their HFA-PEFF score into intermediate (2–3 points) and high (4–6 points) score groups. The primary outcome was all-cause mortality. Of 1018 patients with AMI and an HFA-PEFF score of ≥2, 712 (69.9%) and 306 (30.1%) were classified into the intermediate and high score groups, respectively. Over a median follow-up of 4.8 (3.2, 6.5) years, 114 (16.0%) and 87 (28.4%) patients died in each group. Multivariate Cox regression identified a high HFA-PEFF score as an independent predictor of all-cause mortality [hazard ratio (HR): 1.53, 95% CI: 1.15–2.04, p = 0.004]. The predictive accuracies for the discrimination and reclassification were significantly improved (C-index 0.750 [95% CI 0.712–0.789]; p = 0.049 and NRI 0.330 [95% CI 0.180–0.479]; p < 0.001) upon the addition of a high HFA-PEFF score to clinical risk factors. The model was better at predicting combined events of all-cause mortality and heart failure readmission (C-index 0.754 [95% CI 0.716–0.791]; p = 0.033, NRI 0.372 [95% CI 0.227–0.518]; p < 0.001). In the AMI cohort, the HFA-PEFF score can effectively predict the prognosis of patients with an HFA-PEFF score of ≥2. Full article

(This article belongs to the Special Issue Acute Heart Failure: Risk Prediction, Diagnosis, and Clinical Management)

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Review

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16 pages, 2939 KiB

Open AccessReview

Decongestion in Acute Heart Failure—Time to Rethink and Standardize Current Clinical Practice?

by Valentin Bilgeri, Philipp Spitaler, Christian Puelacher, Moritz Messner, Agne Adukauskaite, Fabian Barbieri, Axel Bauer, Thomas Senoner and Wolfgang Dichtl

J. Clin. Med. 2024, 13(2), 311; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13020311 - 05 Jan 2024

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Abstract

Most episodes of acute heart failure (AHF) are characterized by increasing signs and symptoms of congestion, manifested by edema, pleura effusion and/or ascites. Immediately and repeatedly administered intravenous (IV) loop diuretics currently represent the mainstay of initial therapy aiming to achieve adequate diuresis/natriuresis [...] Read more.

Most episodes of acute heart failure (AHF) are characterized by increasing signs and symptoms of congestion, manifested by edema, pleura effusion and/or ascites. Immediately and repeatedly administered intravenous (IV) loop diuretics currently represent the mainstay of initial therapy aiming to achieve adequate diuresis/natriuresis and euvolemia. Despite these efforts, a significant proportion of patients have residual congestion at discharge, which is associated with a poor prognosis. Therefore, a standardized approach is needed. The door to diuretic time should not exceed 60 min. As a general rule, the starting IV dose is 20–40 mg furosemide equivalents in loop diuretic naïve patients or double the preexisting oral home dose to be administered via IV. Monitoring responses within the following first hours are key issues. (1) After 2 h, spot urinary sodium should be ≥50–70 mmol/L. (2) After 6 h, the urine output should be ≥100–150 mL/hour. If these target measures are not reached, the guidelines currently recommend a doubling of the original dose to a maximum of 400–600 mg furosemide per day and in patients with severely impaired kidney function up to 1000 mg per day. Continuous infusion of loop diuretics offers no benefit over intermittent boluses (DOSE trial). Emerging evidence by recent randomized trials (ADVOR, CLOROTIC) supports the concept of an early combination diuretic therapy, by adding either acetazolamide (500 mg IV once daily) or hydrochlorothiazide. Acetazolamide is particularly useful in the presence of a baseline bicarbonate level of ≥27 mmol/L and remains effective in the presence of preexisting/worsening renal dysfunction but should be used only in the first three days to prevent severe metabolic disturbances. Patients should not leave the hospital when they are still congested and/or before optimized long-term guideline-directed medical therapy has been initiated. Special attention should be paid to AHF patients during the vulnerable post-discharge period, with an early follow-up visit focusing on up-titrate treatments of recommended doses within 2 weeks (STRONG-HF). Full article

(This article belongs to the Special Issue Acute Heart Failure: Risk Prediction, Diagnosis, and Clinical Management)

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